Dr. Gary Huber recently gave a lecture on what’s new about testosterone. His talk was presented at the 24th Annual World Congress on Anti-Aging Medicine (Dec. 9-11, 2016) in Las Vegas that I attended. It was entitled “Evolution of Testosterone – Dispelling Myths & Charting a Future”.

History of testosterone

There are some notable historic landmarks with respect to the discovery of testosterone.

1869: Dr. Charles Brown-Sequard suggested that the “feebleness of older men” was due to a lack of testosterone. He injected himself with testicular extracts from dogs and guinea pigs.

1912: The Danish physician Dr. Thorkild Rovsing transplanted the testicles of a young soldier killed in battle into an old man with gangrene. The gangrenous wound healed completely.

1918: Dr. Leo Stanley sampled fresh testicles from executed prisoners at the San Quentin Prison and transplanted them to prison inmates. Some regained their sexual potency.

1930’s: Professor Adolf Butenandt collected 25,000 liters of urine from willing policemen. He was able to isolate a breakdown product of testosterone, androsterone. Eventually he isolated both progesterone and testosterone. He received the Nobel prize for his work with sex hormones in 1939.

Historical detours and misguided opinions about testosterone

This allowed the new substance, 17 alpha-methyltestosterone to be swallowed as a pill. But the liver changed 17 alpha-methyl-testosterone into 17 alpha-methyl-estradiol, a strong estrogenic compound. This was not well metabolized. Shortly after introduction into patients it became evident that 17 alpha-methyl-testosterone caused liver cancers. This “testosterone equivalent” was used for 50 years until the FDA outlawed it because I caused liver cancer. It also caused suspicion among physicians about any testosterone replacement, even the bioidentical hormones that are safe.

Prostate cancer myths

Prostate cancer myth

Conventional medicine teaches (and I have believed this for many years) that testosterone would be the cause for prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients a bit. Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen. When an orchiectomy was done (because of the belief that testosterone production was the culprit) inadvertently the real cause of prostate cancer (an estrogen surplus) was also removed, thus improving the survival of these patients somewhat. Nowadays we have more sophisticated testing methods. Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot of more modern references, that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops as stated above because of the low testosterone and low progesterone during the male menopause (also called “andropause”).

It is important, when testosterone deficiency is present in an aging man, to replace the missing testosterone with bioidentical testosterone.

The old method of hormone depletion therapy in advanced prostate cancer cases is still practiced today, but has been proven wrong by Dr. Morgentaler and other researchers.

10% absorption rule myth

For years there has been a persistent myth that only 10% of testosterone would be absorbed through the skin. This was never proven, and newer studies could demonstrate that about 90% of testosterone gets absorbed through the skin.

Misleading science created myths

Unfortunately three key medical journals, JAMA, NEJM and PLOS ONE have published misleading studies. The content did not discuss physiology, mechanism of actions, appropriate dosing or true science. But their conclusions were that testosterone therapy was associated with heart attacks and strokes. There was an outcry about this particular study in the medical community reflected in the demand to retract this misleading article.

Unfortunately there were more similar false “studies” where controls were wrong or unequal groups were compared that should not have been compared. It is reminiscent of previous effort of the tobacco industry wanting to cover up that cigarette smoke causes lung cancer.

Here we have the problem that testosterone cures so many conditions for which the Pharma industry has many patented medicines that control the symptoms. But testosterone can actually treat the cause of the illness, testosterone deficiency, which leads to a cure of many other symptoms.

For a long time physicians were confused. But younger physicians are replacing the older generation and they treat testosterone deficiency with bioidentical testosterone in the proper dose.

Clinical observations about a lack of testosterone

As this paper shows, men investigated in the 1980’s were still having higher testosterone levels in older age. But in the 1990’s and more so in 2004 these values have declined even more. This fact coincides also with other studies, showing decreased sperm health and increased infertility. The reason for this is also a lack of testosterone!

Causation of low testosterone

Dr. Huber pointed out that many studies have pointed to a variety of causes for low testosterone levels in men.

BPA, toxins and pesticides that occupy testosterone receptors and interfere with the hypothalamus/pituitary hormone function that stimulates the Leydig cells to produce testosterone.

The more stress men are under, the less testosterone production there is. Sleep deprivation below 5 hours per night leads to a significant lower testosterone production. Most testosterone is produced during the sleep in the early morning hours.

Many references were provided that support these data. In one paper it was noted that the risk of a heart attack climbs to 4 times the risk of normal, when the man sleeps less than 6 hours per night. As sleep hours lower, the risk for metabolic syndrome increases by 42% and this leads to heart attacks. Testosterone replacement can reverse this risk as it a lack of testosterone production that caused the risk.

Link of low testosterone to cardiovascular disease

The literature is overwhelming that low testosterone has adverse effects on the cardiovascular system. To be more specific, the metabolic syndrome, heart disease (and strokes), diabetes and high blood pressure have their root in low testosterone.

Metabolic syndrome

Inflammation is mediated by cytokines such as IL-6. Dr. Huber mentioned one study where healthy men received IL-6. This promptly suppressed testosterone levels. He said that there are many cytokines that work in concert to suppress testosterone. One useful clinical test for inflammation is the C-reactive protein, which indicates whether or not inflammation is present in a person. Metabolic syndrome is common in obese patients. In a study CRP was found to be significantly associated with obesity. When CRP is high, testosterone levels are low. When the CRP level is high, there is a risk of getting the first heart attack.

On the other hand, when men with high inflammatory markers from low testosterone levels were replaced with testosterone, the tumor necrosis factor was reduced by 50%, IL1b by 37%, triglycerides by 11% and total cholesterol by 6%.

In the Moscow study a group of obese men with low testosterone levels were treated with testosterone injections. There was an impressive reduction of insulin (17%), CRP (35%) weight reduction of 4% and TNF-a reduction of 31% within 16 weeks.

Heart disease (and strokes)

Hardening of the arteries (medically called atherosclerosis) is due to chronic inflammation. A new heart attack/stroke specific biomarker has been developed. It is a ratio of oxidized LDL, divided by HDL. This has an odds ratio of 13.92 compared to a control without a risk for a heart attack or stroke.

Administration of testosterone hormone led to dilatation of coronary arteries. The Rotterdam study showed that low testosterone levels were associated with high risk for heart attacks and strokes, but that treatment with testosterone removed this risk. Testosterone increases AMP kinase for energy production in heart muscle cells, but also dilates coronary arteries for more blood supply to the heart.

Diabetes

Among men with diabetes 20-64% have low testosterone levels. In another study men with higher testosterone levels had a 42% lower diabetes risk. Testosterone levels are inversely related to body mass index and insulin resistance. Men with diabetes have lower testosterone levels than men who were not diabetic and were weight-matched. Most diabetics have high CRP values.

High blood pressure

Experience with androgen deprivation therapy for prostate cancer has shown that blood pressure gets elevated due to testosterone deficiency. Testosterone increases LDH, the protective subunit of cholesterol, and decreases LDL cholesterol and triglycerides. Testosterone also lowers inflammatory markers and reverses clotting factors making blood thinner. All of this leads to a widening of the arteries and lowering of blood pressure.

Treatment options for low testosterone

It is important to support the hypothalamic /pituitary/adrenal gland axis and remove other causes, such as stress and lack of sleep. Younger men can be stimulated in the pituitary gland through Clomiphene. Men older than 60 likely have true secondary hypogonadism and need testosterone replacement. Topical testosterone creams are available commercially or from compounding pharmacies. Injectable testosterone preparations that can be metabolized by the body are available. One such preparation is Delatestryl. A small dose (like 50 mg) is self-injected subcutaneously twice per week, which keeps the testosterone level stable. The last resort, if the creams or injections don’t work, is the use of testosterone pellets that a physician can implant under the skin.

What’s new about testosterone?

Conclusion

At a recent Anti-Aging conference in Las Vegas that I attended, Dr. Huber gave an overview of testosterone. There has been an objective reduction of testosterone levels in men since the 1980’s due to pollutants in our environment. Testosterone plays a key role for heart and brain function. It affects sex drive, fertility and potency. But it also prevents diabetes, high blood pressure and weight gain. On top of that it prevents prostate cancer and likely many other cancers. The key with low testosterone is to replace it to high normal levels. Blood levels should be measured every two months, when replacement has been instituted, in order to ensure adequate levels.

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The June issue of Life Extension reviewed a new prostate cancer treatment. Prostate cancer affects about 180,000 men per year and 28,000 die every year from prostate cancer metastases. Dr. Gary Onik, interventional radiologist in Ft. Lauderdale, FL, developed a new prostate cancer treatment protocol. Two years ago he published a medical paper about a 10-year follow-up on a group of 70 prostate cancer patients who had been treated by him.

New prostate cancer treatment protocol

Usually it is a rising prostate specific antigen test (PSA) that tells the treating physician that not all is well with the patient’s prostate gland. In the last two years a new more specific and very sensitive genetic screening test has been developed, called Oncoblot test. If this is positive for prostate cancer, it is almost as good as a prostate biopsy that shows the cancer cells directly. But at this point the medical profession does not accept the Oncoblot test as being proven reliable despite the fact that the FDA has approved it for cancer screening.

The gold standard: a transrectal prostate biopsy has been considered the “gold standard” for the last several decades. However, 14 years back Dr. Onik decided to develop a more meaningful and more reliable prostate mapping biopsy. With this 3-dimensional mapping biopsy the examiner inserts many biopsy needles through the perineum, the skin between the base of the scrotum and the anus. The location of the needles are carefully kept track of and sent to the pathologist for histological analysis. This way the biopsy results can be projected as a 3-dimensional image of the prostate cancer on a computer screen. This becomes the basis for the next step in the treatment protocol.

Cooling probes are introduced through the perineum and placed exactly where the prior prostate mapping biopsy located the cancer. It is this closely controlled placement of the treatment probes that ensures a much higher treatment success rate compared to the “gold standard” of the robotic prostatectomy (removal of the prostate gland).

The patient is followed up with PSA blood tests at 3-monthly intervals until the level is low and stable. Should there be any rise in PSA the patient is reexamined with another prostate mapping biopsy and treatment may have to be repeated until the PSA is low or negative again.

10-year follow-up of 70 men with prostate ablation therapy

Dr. Onik followed 70 prostate cancer patients using the above protocol for a total of 10 years. The patient’s age was between 45 and 77 years at he time of surgery. 66 of Dr. Onik’s patients survived until the end of 10 years. The four who passed away, died of causes other than prostate cancer making the “disease-specific” survival rate 100%. PSA stability was achieved in 89% of the patients.

High risk and low risk survival data with new prostate cancer treatment

Prostate cancer patients can be classified into high-risk, medium-risk and low-risk. This is done based on the histological characteristics of the cancer, the Gleason score (a measure of how aggressive the cancer is), the stage (based on the extend of the cancer) and the height of the PSA level.

Using conventional treatment (prostatectomy) long-term follow-up data show that low-risk patients have a disease free survival of 85%, while high-risk prostate cancer patients have a success rate of only 45%.

In contrast to this Dr. Onik’s protocol achieved a biochemical disease-free survival of 90% for low-risk patients, 88% for medium-risk patients and 89% for high-risk patients. Surprisingly there seems to be no difference with regard to the long-term outcome of any of the risk levels. This is unique for the Onik method of focal cryoablation therapy.

What is focal cryoablation therapy, the new prostate cancer treatment?

The prostate cancer is frozen much like a wart is frozen by liquid nitrogen treatment in the doctor’s office. In the case of prostate cancer ablation liquid Argon is used for freezing. The application is closely controlled temperature wise using heat probes to ensure adequate freezing. Special cooling probes are brought to the cancer areas that were identified by the prostate mapping procedure beforehand. The freeze/thawing is done three times. This way a 100% kill of all of the cancer cells is achieved at the time of the procedure. The treatment for every patient is individually geared to his condition.

Comparison of focal ablation treatment with traditional prostatectomy

After 5 years of prostate mapping biopsies Dr. Onik published a study where he looked at 180 men who had been diagnosed with prostate cancer on one side of the prostate gland by standard rectal biopsies. When he did mapping biopsies involving the whole prostate gland he noticed the following:

61.1 % (110 patients) had cancer on both sides of the prostate

22.7 % (41 patients) who had been classified having a cancer with a low-grade score increased to an intermediate-grade score

19.4 % (35 patients) had cancer growth in very close proximity to either nerve bundles or blood vessels.

69.4% of those patients who had been diagnosed as having only low-grade, one-sided tumors were found to have more extensive cancers. With the previous classification they were thought to need only active surveillance (also known as “watchful waiting”). But with the detailed mapping biopsy results they now had at least one finding that reclassified their disease to requiring a more aggressive cancer treatment protocol. Other physicians have found the same thing when looking at these patients with more sensitive MRI scans. The prostate cancers were more extensive than when depicted with simple MRI scans. In some patients where areas on one side of the prostate seemed free of cancer using traditional MRI’s, now showed cancer on both sides using the more sensitive MRI scanners. Also using blind rectal biopsies, which is the standard technique that most radiologists use, can often miss prostate cancers that are found with sensitive MRI scanners or Dr. Onik’s mapping biopsy.

Complication rate with new prostate cancer treatment

The recurrence rate of prostate cancer treated with cryotherapy ablation therapy after 10 years was only 4%. Compare this to a study where prostate cancer was treated with radiotherapy. After 10 years the biochemical disease free survival for low risk patients was 78%, for medium risk 78% and for high risk 62%. This translates into cancer recurrences of between 22% and 38% depending on the risk stratification. The so-called golden standard procedure (robotic prostatectomy) showed the following: in a study that went on for 5 years there was a 28% overall recurrence rate. When the margins of the prostatectomy were examined, the following amounts of cancer had remained: 23% for low risk patients, 29% for medium risks and 42% for high risks.

Urinary continence was maintained in 100% of the cases meaning that the nerves going through the prostate gland were preserved.

Only 6% of patients treated with ablation therapy had problems with sex 10 years after the procedure. This compares favorably with the other treatment modalities that have much higher rates of sexual problems.

Overall cryoablation therapy is very well tolerated and removes tumor tissue exactly where the 3-D mapping biopsy findings show the prostate cancer to be located. This helps the patients’ survival rates.

What are the reasons for treatment failures with conventional prostate cancer?

Blind prostate cancer biopsies are generally trans-rectal procedures. They lead to infections of the prostate, in rare cases even to blood poisoning (septicemia), but they often miss cancers that are present when mapping biopsies are done. With rectal biopsies only 8 to 16 biopsies are done. They are blind, the physician does not know exactly where the biopsies came from. With the mapping biopsies the doctor keeps track carefully where the biopsies originated from and they are sent separately to the pathologist. With the mapping biopsy 60 to 90 biopsies are taken depending on the size of the prostate gland. There is a much higher resolution of the area where the prostate cancer is located. This helps the physician where to focus the cryoablation treatment.

Poor diagnostic tests prior to cancer surgery lead to missed prostate cancer removal, which in turn lead to recurrences. Total prostatectomy (robotic prostatectomy) is not total, but only 70% are removed, leaving chunks of prostatic tissue behind. Often it is there where undiagnosed prostate cancer is left behind. This explains the poor 5-year follow-up results of 23% to 42% recurrence rates after the “gold standard prostatectomy”.

Only the mapping biopsy that depicts the entire prostate gland (which is done perineally to prevent infection) can show exactly where the cancer is located. This is subsequently removed in its entity.

The cryoablation therapy is likely stimulating the immune system to send killer T cells to help with the destruction of any remaining cancer cells. This may partially explain the low 10-year recurrence rate of only 4%.

New Prostate Cancer Treatment

Conclusion

Dr. Onik, an interventional radiologist from Ft. Lauderdale, FL, has developed a new focal ablative prostate cancer treatment. He showed in a study going on for 10 years that it is superior to either radiotherapy or robotic prostatectomy. With the baby boomers aging and prostate cancer being a disease of aging men, this has just arrived in time to be beneficial to any man who is diagnosed with prostate cancer. Most patients are suspected to have prostate cancer when their PSA value gets elevated above 4 or 5. Instead of taking a risk of blood poisoning with E. coli or developing prostatitis from the transrectal biopsy approach, the patient may want to consider having the 3-dimensional mapping biopsy done by Dr. Onik in Ft. Lauderdale. This is done through the perineal approach, which shows the exact location of the cancer. Using cryotherapy probes with liquid Argon the cancer is focally treated, which is similar to a lumpectomy in a woman with early breast cancer. Cancer recurrence rates at 10 years were only 4%. The good news is that a mapping biopsy of the prostate can be repeated, if rising PSA levels should occur in future. This shows whether there is a cancer recurrence, and this can be treated again with cryotherapy. The future will see more physicians embrace this method, as several centers are being planned in the United States. They will very likely replace a “gold standard” of prostate cancer treatment that is less than perfect.

One of the driving hormones in a man is testosterone. It also is known that with age testosterone levels fall. The lesser known fact is the importance of monitoring testosterone levels in aging males, so they have the choice of intervening with the aging process. Here are the facts about testosterone, about replacement of testosterone and about the anxieties of the medical profession to deal with this.

Androgen receptors contained in key tissues

Androgen receptors are situated in the key organs like the brain, heart, muscles, bones, kidneys, fat cells, genitals, hair follicles and skin. They respond to all male hormones, called androgens, like testosterone, dihydrotestosterone (DHT) and DHEA. DHT is produced by metabolizing testosterone with the help of an enzyme, called 5α-reductase in the adrenal glands. This is responsible for hair loss in males and some females. There is a genetic factor for this. It is important that the man continues to have all tissues stimulated by testosterone when he ages or the key organs mentioned are going to suffer.

A lack of testosterone as the man ages (around 55 to 65) leads to a slowdown in thinking, osteoporosis in the bones, muscle atrophy (melting in of muscle tissue), and a lack of sex drive. Mood swings can turn the male into the “grumpy old man”. The skin gets thinned and is more brittle.

Animal experiments have shown that the development of fatty streaks in blood vessels happens at a higher rate in castrated animals. The more encouraging finding in these animals is the fact that this condition is reversible by replacement of testosterone. In healthy males of a younger age all organs are working well. The problems starts when males age and the hormone regulation in the brain slows down, which ultimately leads to andropause in males, the equivalent of menopause in women. When testosterone is replaced in an aging man with low testosterone levels, the androgen receptors in key organs mentioned above are stimulated and normal organ function returns.

Reluctance of physicians to prescribe testosterone

It used to be taught to medical students that testosterone would be the cause for prostate cancer. This was based on old observations by Dr. Huggins, a Canadian born surgeon who practiced in Chicago, that orchiectomy improved the survival of advanced prostate cancer patients by a small percentage. Dr. Lee pointed out that Dr. Huggins neglected to realize that testicles make both testosterone and small amounts of estrogen.

When an orchiectomy was done (because of the belief that testosterone production was the culprit) inadvertently the real cause of prostate cancer (an estrogen surplus) was also removed thus improving the survival of these patients somewhat. Nowadays we have more sophisticated testing methods. Dr. Abraham Morgentaler (Ref. 1) has compiled a lot of evidence about the importance of testosterone in men. He proved, based on a lot more modern references that it is not testosterone that is the cause of prostate cancer. We know now that estrogen dominance is responsible for prostate cancer and that this develops as stated above because of the low testosterone and low progesterone during the male menopause (also called “andropause”). Dr. Morgentaler, a urologist from Harvard University has taken prostate cancer patients and put them on testosterone. To his and everyone else’s surprise testosterone treated prostate cancer patients improved, their prostate cancer either disappeared or become much less aggressive, which can be measured with the Gleason score based on its microscopic appearance. The result was that they did better, not worse on testosterone.

Unfortunately the history of testosterone, orchiectomy and prostate cancer as explained led to confusion among the medical profession. We now know that testosterone is innocent with respect to prostate cancer, testicular cancer or any other cancer. But some of the old-timers among the physicians doggedly hold on to their false belief from the past because they were taught this way. If a man asks one of these physicians for testosterone replacement he may not only be told that he/she could not do that, but will also receive a tirade of false statements about testosterone.

We dealt with the myth of prostate cancer that is not related to testosterone treatment. There is another myth that older physicians often cite: that testosterone would supposedly be causing blood clots. At the University of Texas Medical Branch at Galveston (Texas, USA) a large study was done involving 30,572 men, ages 40 years and older. They all had venous thromboembolism and received an anticoagulant drug or an intravascular vena cava filter following their diagnosis. They also had a low testosterone level and were given testosterone replacement therapy. They were followed and monitored for further venous thromboembolism. None were found in any of the men. The conclusion of the investigators was that filling a testosterone prescription was not associated with any clotting condition.

Aging and testosterone

The Massachusetts Male Aging Study showed that testosterone has been declining in the male population over a period of 20 years. Partially this was related to aging, but otherwise there may also be environmental factors, called estrogen-like substances or xenoestrogens, that have contributed to it as well. Although age is a factor, there is so much variation from man to man, that it is best to just measure testosterone and determine whether the total testosterone level is above or below 500 ng/dL. This seems to be the most reliable indicator in determining whether a man needs hormone replacement, apart from symptoms due to testosterone loss. These are: increased risks for prostate problems and/or cancer, cardiovascular disease, loss of bone density, a rise in cholesterol and urinary dysfunction. Dr. Randolph describes this in detail and also discusses who needs bioidentical testosterone replacement.

A New England Journal of Medicine study from September 2013 explained that apart from testosterone the male body needs a small amount of estradiol, the female hormone for normal functioning. This is achieved through the enzyme aromatase contained in fatty tissue. But testosterone replacement must be given as the bioidentical testosterone, so that a small amount of it can be converted by aromatase into estradiol. I have reviewed this in a blog entitled “The Full Story About Testosterone”.

Risk of prostate cancer

Having reviewed the hard facts about prostate cancer risk, it is now clear that older men get prostate cancer because of lowered testosterone in their blood and increased body weight, where fat converts androgens by the aromatase into estradiol; this leads to estrogen dominance. Estrogen dominance causes breast cancer and uterine cancer in women and prostate cancer in men. When the total testosterone level in a man is lower than 500 ng/dL it is a sign that he needs testosterone replacement therapy to protect his prostate from prostate cancer.

Cardiovascular disease

As the cardiovascular system has a lot of androgen receptors on its cell surfaces, it is important that the man continues to have the proper stimulus from androgenic hormones (testosterone, dihydrotestosterone and DHEA) for proper contractility of heart cells and relaxation of smooth muscle cells in the arteries to control blood pressure. With a lack of testosterone there is hardening of the arteries, loss of muscle cells in the heart muscle and increase of blood pressure. So far there is only an indication that low testosterone is associated with diabetes, high blood pressure and heart attacks. It has not been proven that it is the cause (so webmd.com says). But careful replacement with bioidentical testosterone helps patients to get rid of their symptoms, have the energy to exercise and feel better. Long-term studies have already shown that hormone replacement saves lives, but the medical profession is slow to accept this (Ref.1). Here is a link that explains this a bit further.

If a man who is low in testosterone wonders whether it would be worthwhile to go on testosterone therapy, here is the clear answer: would you like to have a 47% lowered risk of dying, a reduction of 18% in heart attacks and 30% reduction in the risk for a stroke? This is what a 14-year follow-up study published in the European Heart Journal in August, 2015 found.

The same is true for cardiovascular disease as stated above: if the total testosterone level in a man is lower than 500 ng/dL it is a sign that he needs testosterone replacement therapy to protect his cardiovascular system to prevent heart attacks and strokes.

Loss of bone density

Older men can get osteoporosis, which can lead to compression fractures in the spine and to fractures in the hip, the ankle or wrist. It is thought that with the lack of testosterone there is also a lack of estradiol via the aromatase pathway in fatty tissue. This small amount of estradiol is thought to prevent osteoporosis all his life until the testosterone drops with older age. Once again it is important to monitor his total testosterone level and replace with bioidentical testosterone when it is lower than 500 ng/dL.

Rise in cholesterol

With obesity the metabolic syndrome sets in where the LDL cholesterol is increased. This is a direct risk for hardening of the arteries. In an obese older man with low testosterone there is a double risk from the low testosterone and the metabolic syndrome. As a result the heart attack and stroke rates in obese men with low testosterone are much higher than in obese men with normal testosterone levels. Men with obesity need to lose weight by changing their diet to healthier eating habits and starting a regular exercise program with swimming and walking. At the same time those with a testosterone level of lower than 500 ng/dL should have testosterone replacement with bioidentical testosterone.

Urinary dysfunction

A hyperactive bladder, dribbling, hesitancy and leaking bladder can all be part of testosterone deficiency. But this is not that easy to diagnose. A full consultation by an urologist may be necessary to assess various other causes that could hide behind these symptoms. Part of the work-up though is to measure the total testosterone level and replace with bioidentical testosterone when it is lower than 500 ng/dL

Alzheimer’s disease

Alzheimer’s disease can be due to a lack of testosterone. It is therefore important to measure the total testosterone level in a man. If it is lower than 500 ng/dL, as mentioned before , it is a sign that he needs testosterone replacement therapy to prevent Alzheimer’s disease.

Burnout

According to Dr. Thierry Hertoghe, an endocrinologist from Belgium, there are several hormones that can be missing in a person with burnout: a lack of cortisol, thyroid, growth hormone, testosterone/estrogen, progesterone and oxytocin. The middle-aged manager with burnout would have other hormones missing apart from testosterone. This needs to be measured with blood tests. Whatever is low would have to be replaced with bioidentical hormones.

Some details regarding testosterone measurements and delivery

The deeper you delve into testosterone replacement, the more details there are to consider.

It is like a storage form of testosterone and only 1 to 2% of the total testosterone is unbound. This is called the free or bioavailable testosterone. Some physicians measure just that portion of testosterone.

Second, when it comes to replacement of testosterone in a man who is deficient for testosterone, there are several delivery systems, which some people find a little confusing. There are testosterone gels, which are least absorbed; another application are creams which are often prepared by compounding pharmacies. These creams are usually well absorbed. But some men do not absorb either creams or gels. They need testosterone injections or testosterone pellets. The goal is to replace testosterone in a manner that there is a fairly equal amount of testosterone available at all times. Some men achieve that only with testosterone pellets, others with testosterone cypionate injections. For this reason blood test that determine the levels of free testosterone are necessary.

Testosterone

Conclusion

Testosterone is a key hormone in the male and needs to be monitored, particularly when he is aging. A careful history of his symptoms needs to be taken by a knowledgeable physician or naturopath. If blood tests show that the total testosterone is less than 500 ng/dL replacement with bioidentical testosterone is needed.

Intuitively you may have noted that older folks who have very little “meat” on them are not as healthy as people of the same age with well-developed muscles.

A research team under the supervision of Dr. Preethi Srikanthan and Dr. Arun S. Karlamangla from the David Geffen School of Medicine at UCLA, Los Angeles, CA decided to measure the muscle mass index instead of the body mass index. They did this using bioelectrical impedance (simple electronic body composition bathroom scales) and they wanted to see whether there would be any correlation with regard to mortality statistics in an older population.

The study group consisted of 3659 participants from the National Health and Nutrition Examination Survey III (average age for males 55 and older, females 65 and older). The survey took place between 1988-1994. Mortality rates were computed by the end of 2004. The median length of follow-up per person was 13.2 years.

The authors of the study compared mortality curves for four subgroups of muscle mass from low to high: 0-25%, 25-50%, 50 to 75% and 75 to 100%. When the lowest muscle mass group was compared to the highest muscle mass group, there was a 20% increased mortality rate for the lowest muscle mass group.

This study had careful controls built in and could demonstrate that the difference was not due to better or worse LDL cholesterol values or triglycerides; it was not due to differences in diabetic rates or other factors. This is the first study that shows in a US based population that a lower than average muscle mass is an independent risk factor for premature death in an older population.

The authors were aware of Danish study that had previously shown that a lower muscle mass was associated with a higher mortality rate in 50 to 64 year-olds.

I like to comment regarding this study by putting it into the context of other medical findings.

Keep Your Muscles In Older Age

1. Older people tend to have more falls

Several studies have shown over the years that older people fall more often because of a combination of balance problems with slower reaction time, and also because of poorer muscle development when compared to a younger age group. The medical costs are staggering when older people reach the age of 85 where about 20% of that subpopulation experience serious falls resulting in hip fractures and hospitalizations. There is a mortality of about 25% associated with hip fractures in that age group. And about 50% of those who survive will not be living independently at 1 year following a hip fracture. Fortunately fractures from falls can largely be prevented by making physical changes to the home to prevent tripping and having extra guard rails where needed. But another important factor is to exercise regularly within the capabilities of the older person to maintain muscle mass, which will balance the body and control upper and lower extremity strength as the person moves around.

2. Fit people live longer

A Stanford University study followed 6000 middle-aged men for 10 years and found that the fittest who exercised regularly were 12% more likely to stay alive for every metabolic equivalent; this is the energy that a sitting person uses in terms of oxygen consumption. They also found that the least fit had a 4.5-fold higher death rate within 6 years from the beginning of the study compared to the fittest.

To put this into perspective: a regular walk at less than two miles an hour would be equivalent to 2 metabolic equivalents, a brisk walk at 4 miles per hour is worth 5 metabolic equivalents and running 6 miles an hour is worth 8 metabolic equivalents. This is how the math works: a regular walk every day translates into 2×12% = 24% more likelihood of staying alive in the next 6 years compared to a sedentary person. A person exercising with a brisk walk with a speed of 4 miles per hour every day would be 5×12% = 60% more likely to be alive in 6 years compared to a sedentary person who does not exercise. Not smoking and having a normal weight would add to your probability of living longer. Pushing yourself to the extreme (running 6 miles per hour) may be problematic for the majority of us as there are issues of getting into adrenal gland insufficiency that can develop, if you over-stress yourself. (This is my comment, not part of the study).

Now you may have wondered about the woman’s side (as the previous study was an all-male study). The answer comes from a recent paper that studied 10 clinical trials throughout the world (US, Denmark, Germany, Sweden, Taiwan and Japan) involving only postmenopausal women. Yes, there is the same surprising finding that regular brisk exercise makes the women live longer with less disabilities and less mortality!

The bottom line: exercise regularly and live.

3.Exercise develops your muscles and maintains them

We were born to use our muscles daily (designed as hunter/gatherers), but in the meantime this is what we do: sitting in front of the computer or TV, in cars, in class (school, university, work) or in the movie theatre. So we need to discipline ourselves to get into a routine that balances all of the other activities. Muscle strength exercises or activities as indicated in this link are the answer.

The earlier we adopt this type of a routine, the better off we are when we reach the golden years of retirement. I am one of the examples of former non-exercisers. Apart from liking to go for long walks 3 to 4 times per week I did no formal exercises until 8 years ago when my wife and I got into ballroom and Latin dancing inspired by “Dancing with the stars”. But it is only about 2 years now that we took up regular gym workouts for 45 to 60 minutes every day. It is now easier for me to walk up on a steep hill in our neighborhood that has an 18% incline than 2 years ago. Muscles need regular exercise. You put a limb in a cast and within 3 weeks most of the muscle strength has melted away. You remove the cast and it will take 3 to 6 weeks of regular exercise to regain the muscle strength. So why not maintain your muscle strength in the first place?

4. Exercise develops cardiovascular fitness

The aerobic part of my daily exercise program (treadmill) develops cardiovascular fitness as the lungs have to work harder and the heart is being activated. Doing this regularly is mimicking going through the landscape looking for food and hunting. Of course most of us drive in our cars to the grocery store and get our food that way. So my balance is to go to the gym and at least once a day get that work-out. What can we expect from fitness training? An NIH study showed that with a moderate work-out of only 2.5 hours per week you will gain 4.5 years of life due to cardiovascular fitness. This is better than money in the account. It is free healthy additional life!

5. Sensible nutrition will help preserve muscle mass

No, I am not taking your food away. I am suggesting that we watch the quality of the food we are consuming. If you are like the average consumer, you may be eating too many carbs in form of pasta, bread, rice and potatoes. Some of you have read in past blogs that my wife and I cut out sugar and starchy foods as well as wheat since 2001. We both lost 50 pounds and kept it down. I know that if I would restart sugar and starchy foods, my fat content would go up, my muscle content down and the BMI up. How do I know? I weigh myself every day on body composition scales (which works by the principal of bioelectrical impedance analysis), which show all of these indicators. Recently I got into some organic Bing cherries. They were delicious, but it also is a fruit with significant sugar content! Within a day I knew that I’d better watch the quantities I consume (fat composition was up, muscles mass down). It took 3 days for my values to be back to normal.

When it comes to muscle mass, overconsumption of refined carbs is one problem; however, our bodies do need quality lean meat and some fish (salmon, mackerel; low mercury fish) as a source of protein. I buy organic meats to get away from the problem of pesticide pollution as much as possible. Some people like vegan food, they may need to supplement with protein supplements.

Conclusion:

It may sound like common sense that a body with well-developed muscles will live longer. You may want to compare this to a well-maintained car (less rust, good maintenance) and the car will still drive well once it has a high mileage.

We have bodies that need maintenance (exercise) and good nutrition (no junk food, sensible diet). If we make this our regular lifestyle, we will develop and maintain muscles. It will keep us in the group with a lower mortality rate compared to sessile persons and junk food consumers.

Nothing happens without any effort. We need to earn muscle fitness for ourselves! Think about it, improve where you need to improve and then maintain it. More than anything else this will pay dividends well into your future.

Although in this recent study from Finland researchers found that grumpiness in older age seems to lead to dementia at a faster rate, I like to emphasize here that there may be an under lying problem of hormone deficiency.

Other studies have shown that in males low testosterone levels are associated with grumpiness and dementia is setting in sooner in those males who are deficient for testosterone. For older grumpy females it is the lack of progesterone that has been found to be deficient and when you replace it, memory comes back, symptoms of menopause reverse themselves and the grumpiness is gone. Testosterone replacement may be required by as many as 1 in 4 men in the their 40’s as is summarized in the article from Great Britain.

How can we tell whether there is a change in an older man? There are quite a few symptoms that can be seen by loved ones around this man: an increase in abdominal girth, shrinking muscles, lack of energy, irritability. The key is to get him to the doctor and ask the doctor to order a bioavailable testosterone blood test.

According to medical research 84% of men and 62% of women in the age group of 57 to 64 have been sexually active in the previous 12 months. Take an older age group of 65 to 74 and still 67% of men and 40% of women are sexually active. Fast-forward to age 75 to 85 and the rate has dropped to 39% of men and 17% of women (Ref.1). A person’s sexual activity is a barometer how well the hormones are balanced. These figures show that bioidentical hormone replacement has not been well accepted. Women have a reason as they were misled by Big Pharma as was shown in the

Older Grumpy People Have Higher Risk Of Dementia

Women’s Health Initiative:

The National Institutes of Health had funded a large study (the Women’s Health Initiative) to clarify what was going on with regard to side effects and effects of HRT.

Unfortunately, synthetic non-bioidentical hormone products were used in these studies (Premarin and Provera) instead of bioidentical estrogen and progesterone. The results of the Women’s Health Initiative were devastating. In 2002 doctors were warned that Premarin and Provera used as HRT would cause increased heart attack rates and breasts cancer, which led to premature death. Overall the placebo group did better than the experimental group and this is why the trial was prematurely stopped. As a result of the wide publicity regarding the negative results of the Women’s Health Initiative postmenopausal women either do not see their physician for hormone replacement or are advised by conventional doctors that only small amounts of Premarin could be used for not more than 5 years for fear of causing breast cancer. Medico-legal considerations are at play and the whole issue of HRT after menopause has been politicized.

Problems now for HRT:

It is like a negative shadow has been cast forward with regard to hormone replacement because of the Women’s Health Initiative. People are still confused and don’t understand that the synthetic hormone-like drugs from Big Pharma are like an ill-fitting key for the hormone receptors in the body whereas bioidentical hormones are the perfect fit.

Otherwise there would not be a 45% drop-off (from 62% to 17%) in sexual activities in women from age 60 to 80. Men have it somewhat easier: their drop rate between age 60 an 80 is also 45% (from 84% to 39%), but as they entered into male menopause 10 to 15 years later than women did with menopause, their sexual activity is still double that of women at the age of 80.

However, if people could overcome their unrealistic fear of bioidentical hormones, hormones that fit the body’s hormone receptors a lot more people would be encouraged to use bioidentical hormone replacements.

What, if the grumpy, old man is willing to see his doctor?

The doctor should look at all of the hormones including a fasting insulin level as hyperinsulinism often complicates hormone replacement. Thyroid, which often is also lowered at an older age should be also tested (T3, T4 and TSH). A saliva hormone test can show a panel of 5 hormones: cortisol, DHEAS, testosterone, progesterone and estradiol. As hormones are in a balance with each other this allows to compute the testosterone to estrogen ratio, which ought to be 20 or higher. But hormones alone are not the answer. There needs to be a combination of proper nutrition (cut out sugar, starchy foods, preferably switch to organic foods to escape the xenoestrogens that foul up your hormone balance), also exercise and use vitamins and supplements. I have summarized all of this in my recent book “A survivor’s Guide to Successful Aging” (Ref.2).

When the hormone tests come back the doctor will likely order the missing hormones (hopefully as bioidentical hormones).

It can take 2 to 3 months before the full effect of bioidentical hormone replacement is seen. But most men will be astounded how well they can feel. He will notice that he does not tire with exercising. His muscle mass builds up; his posture improves. His stamina comes back. He will find that the previously foggy thinking is gone and his thought processes have become clear again. And yes, his sex live comes back. So now he has to talk to his sex partner about her bioidentical hormone replacement so they both can enjoy the benefits!

Hidden benefits of bioidentical hormone replacement:

The bones become stronger, the heart beats harder and better, the brain thinks clearer, because the key organs like the brain, the heart and the bones have the appropriate hormone receptors (in both sexes). No, this is no exaggeration. This can be measured by an exercise tolerance test (for the heart). Bone density can be measured and has been done (2% to 4% increase per year). Brain function is indirectly visible to the people around the person: apart from new vitality, improvements in mood and more energy, the grumpiness is gone and the person is perceived as a pleasant person once again.

Conclusion:

The observation of an “old, grumpy man” when he entered the male menopause is accurate, but should not distract from the fact that he has a responsibility to look after himself. It is important to recognize that it is not only women who enter the menopause, but that men 10 to 15 years later will do the same. Both sexes enter a state of hormone disbalance that is treatable. The answer is to replace the hormone deficiency with the missing bioidentical hormones.

Much has been written about what happens when women get into menopause. This begs the question: do men experience a change of life? As a matter of fact, they do. It is called “andropause”, and they can experience problems as a result. Here is a study from the Massachusetts General Hospital in Boston, MA, which was published in the New England Journal of Medicine (Sept. 2013) describing in detail what happens when men get into andropause (the male equivalent of the menopause).

We know from other studies that in obese men testosterone is converted into estrogen because of the enzyme aromatase that converts testosterone into estrogen resulting in erectile dysfunction and loss of sex drive. In lean men above the age of 55 there is a true testosterone reduction because the testicles produce less testosterone. This results in less sex drive, moodiness and lack of energy. But these men will do well with bioidentical testosterone replacement.

Main findings of the Massachusetts General Hospital study:

Testosterone was responsible for thigh muscle development and leg press strength, for erectile function and sexual desire.

Surprisingly, estradiol (the main estrogen component in both sexes) plays a significant part in sexual desire in the male. This became particularly apparent in the post-andropause male who desired hormone replacement. When bioidentical testosterone is used to replace what’s missing there was no problem with sexual desire or erectile function as a small amount of the testosterone was aromatized into estradiol. The researchers were able to measure both testosterone and estradiol levels.

Here is a surprising fact: a lack of estrogen leads to abdominal obesity. This could also be verified by hormone measurements.

In the past doctors used synthetic testosterone products like methyltestosterone, danazol, oxandrolone, testosterone propionate, testosterone cypionate or testosterone enanthate. The problem with these synthetic testosterone products is that the body cannot metabolize a portion of them into estrogen that is desirable for a normal sex drive, so the testosterone compounds alone are not doing their job as well as the bioidentical testosterone that the body can aromatize.

In obese men the problem is that there is too much estrogen in the system, which leads to a disbalance of the hormones in the male with a relative lack of testosterone. Overweight and obese men produce significant amounts of estrogen through aromatase located in the fatty tissue. Aromatase converts testosterone and other male type hormones, called androgens, into estrogen. Excessive levels of estrogen cause breast growth, muscle weakness, lead to abdominal fat accumulation, heart disease and strokes. Dr. Lee described what happens in men who enter andropause years ago as indicated under this link.

The Full Story About Testosterone

Testosterone to estrogen ratio:

Dr. Lee indicated that in his opinion saliva hormone testing is more reliable than blood tests (Ref. 1). One of the advantages of doing saliva hormone tests of estrogen and testosterone is that you can calculate directly the ratios of these two hormones. In hormonally normal younger males the testosterone to estrogen ratio is larger than 20 – 40 (Ref.2). The testosterone to estrogen ratio in obese men is typically less than 20 meaning it is too low. But lean men in andropause produce too little testosterone and their testosterone to estrogen ratio is also less than 20, because they may still have enough estrogen in their system from aromatase in the fatty tissue, but they are lacking testosterone due to a lack of its production in the testicles (Ref. 1 and 2).

When a man in andropause is given bioidentical hormone replacement with a testosterone gel or bioidentical testosterone cream this is absorbed into the blood and body tissues and then partially metabolized into a small amount of estrogen. This can be seen when saliva hormone tests are done; a higher level of testosterone is detected and much lower estrogen level so that the testosterone to estrogen ratio is now 20 to 40 or higher and the affected person will no longer be the “grumpy old man” that had been a source of distress to his partner before.

This New England Journal of Medicine study is important because it confirmed what anti-aging physicians had been saying for years: a small amount of estrogen is necessary for the male for bone health as estrogen receptors will regulate the bone density, it also helps for a normal sex drive. The same is true for women: a small amount of the opposite hormone (testosterone) will help a woman’s sex drive, but she needs the right mix of progesterone to estrogen (a progesterone to estrogen ratio of 200:1 using saliva tests) to feel perfectly normal as a women.

Health and well-being of a man depend on normal testosterone levels:

It is important to realize that testosterone is not only supporting a man’s sex drive and libido, key organs like the heart, the brain and blood vessels contain testosterone receptors as well. The body of a man was designed to respond to testosterone all along. It is when testosterone production is no longer keeping up that premature aging becomes apparent, as the target organs do no longer receive the proper signals.

A healthy heart in a man depends on regular exercise and testosterone stimulation whether he is young, middle aged or old. The same is true for the lining of the arteries where testosterone receptors are present to help with the normal adjustment to exercise and relaxation. The brain cells have receptors for all of the sex hormones and in a man they are used to higher levels of testosterone and lower levels of progesterone and estrogen. If you take the balance away, the aging man will feel miserable and grumpy. Depression will set in. Here is a brief review how one man’s life has been changed by testosterone replacement.

When a man reaches the age of 55 or older there comes a point where a lack of testosterone and estrogen sets in. It is wise to start doing intermittent blood or saliva hormone tests before this point is reached in order to gage when bioidentical hormone replacement treatment should be given. Along with an assessment regarding the hormone status it would be wise to also assess lifestyle issues as often other factors play a role in premature aging. I have reviewed these factors systematically in a recent publication (Ref. 3). It is best to combine bioidentical hormone replacement with life style interventions to achieve optimal preservation of a man’s health.

Our ancestors were hunters and gatherers, constantly on the go. They did not have to think too much about their muscle and joint health, they simply moved them. In our society this has changed a lot. At work we spend hours sitting at a desk, and then we use computers and watch television at home. Instead of walking to the neighborhood store, we use our car.

Here I will review what we can do to keep our joints and muscles in top shape until a ripe old age.

Brief intro regarding the anatomy of joints and muscles

Our joints are designed to give us full mobility. But the joints cannot do it alone. The muscles are designed to allow the joints to move in a full range. Without exercise the muscles will shrivel up (medical term “atrophy”) within only 2 to 3 weeks. So without regular exercise your joints won’t do you any good. Besides the joint capsules need regular stretching in full range exercises to produce the lubricating fluid (synovial fluid) that nourishes the joint surfaces and the menisci of the knees. Think of muscles and joints as being a functional unit designed to move you about.

Our joints have aerodynamic designs to do the most optimal job for our body. For instance the knees have more of a hinge design that includes menisci for shock absorption while the shoulders and hips have more of a ball and socket type construction.

Wear and tear with aging

It is usually thought that injuries and aging wear down the joints. But there are other factors such as the wide spread use of statins that can contribute to muscles weakness. Ironically statins are taken to protect the heart, but side effects can interfere with the ability to exercise your heart because of aching muscles and joints.

With optimal nutrition and avoidance of wheat and wheat products to prevent autoimmune arthritis (lupus, rheumatoid arthritis, dermatomyositis) your joints can stay young for much longer (explained further below). But your joints and muscles need to move through a full range of motion regularly to keep the blood circulation and nutrition of their tissues in top shape.

What causes joint deterioration?

Aging, weight gain, diabetes, smoking and lack of exercise all are known to cause a worsening of arthritis, particularly osteoarthritis, but also rheumatoid arthritis. The wrong diet with lots of sugar and starch and trans fats (hamburgers, pasta, sugar soda drinks) causes hyperinsulinemia (insulin overproduction, like in type 2 diabetes) and is almost guaranteed to make you sick with arthritis, obesity and diabetes.

There is also evidence that wheat causes inflammation and arthritis by stimulating your pancreas to produce too much insulin. This has been proven for dogs and for humans. A good diet book to follow is Dr. William Davis “Wheat Belly Cookbook” (Ref. 1) with 150 recipes. If you are overweight, these recipes will also help you to lose some weight effortlessly.

A caution to marathon runners: the constant pounding of prolonged jogging can cause osteoarthritis of hips and knees decades down the road. You may want to switch to different exercises before this happens.

Preserve Your Muscles And Joints

What helps joints?

Molecularly distilled omega-3 fatty acid helps to prevent inflammation of your joints. Vitamin D3 will help your bones to be strong to support the tendons and ligaments. Chicken cartilage can build up joint cartilage within a few weeks! So, if you feel pain in your joints use 3 capsules of omega-3 (the strong, molecularly distilled ones) twice per day. This will help your joint inflammation within 3 to 4 weeks. If this alone is not enough add chicken cartilage from the health food store, which will help to build up the hyaline cartilage within your joints. For those who are questioning the effect of chicken cartilage, here is a 1993 chicken cartilage Harvard study proving it.

Below are more general steps that will help your joints, ligaments and muscles.

Maintaining health of joints and muscles

a) It starts withgood nutrition.

Hamburgers and deep fried French fries will not do the trick. Muscles require protein from meat, fish, poultry and dairy products. If you are a vegetarian you need to become knowledgeable on what essential amino acids are and what combination of vegetables will give you the amino acid composition to build up a full protein.

Joints need ingredients from cartilage, which you find in chicken cartilage (available in health food stores as fikzol (type II cartilage). I you prefer, chicken soup would also give you the ingredients to build up cartilage, but it would require a lot of regular chicken soup consumption to achieve this.

Sugar and starchy foods, which are broken down within half an hour after a meal into sugar in your blood, cause an insulin response from your pancreas. This in turn can cause inflammation in your joints and tendons. It is interesting to note that type 2 diabetes and arthritis are associated. A ketogenic, low sugar/starch diet will prevent arthritis and diabetes as it reduces the insulin level in the blood, which in turn turns off inflammation in the joints.

b) Supplements:

Omega-3 fatty acids will help control any inflammation including the inflammation from arthritis (you need 3 capsules of the concentrated, molecularly distilled fish oil twice per day to achieve this). DMSO gel, available in health food stores in the US, can also be used to rub onto inflamed joints. It will penetrate tissues rapidly, is nontoxic and helps control inflammation along with the omega-3 fatty acids. Regular anti-inflammatory pain relievers (NSAIDs) are harsh on your kidneys and can irritate the gastric lining causing bleeding gastric erosions, so definitely not recommendable.

Glucosamine, chondroitin sulfate, or a combination of both is available in the health food store and has been shown to help with osteoarthritis. I contributes to building up hyaline cartilage.

You need to move your joints, ligaments and muscles every day to maintain their strength and range of motion. A daily workout at home or in a gym is best. I recommend 30 minutes of a treadmill or equivalent (jogging, Stairmaster etc.) as aerobic exercises. Then you need 30 minutes of isometric exercises like a circuit on exercise machines in the gym or dumbbells and expanders (resistance bands) at home. I consider this as the basic fitness routine every day.

Ballroom dancing and Latin dancing or Zumba is also a good combination exercise, which I would recommend on top of the basic exercise. Dancing helps to maintain your balance as well, which is something the older population tends to lose. In addition dancing stimulates your brain cells and makes you less vulnerable to develop dementia in old age.

Other aerobic exercises that can be recommended are walking (brisk walk) and/or intermittent jogging. Swimming has the advantage particularly for arthritis sufferers that you are floating. It allows you to exercise your leg and arm muscles, even if you have some arthritis pains.

e) Pain relief: What could you do for pain relief? I do not like NSAIDs as this will damage your kidneys on the long-term and cause gastric erosions that can bleed massively. Electro acupuncture is very useful for muscle and joint pains and has no side effects. Physiotherapy treatments are useful to recondition your muscles and build up the range of motion of your joints. Chiropractic treatments for back and neck pain will also help. Instead of narcotics, why not try low dose Naltrexone (LDN). It has been shown to help with the pain of fibromyalgia.

Conclusion

In this brief review I have attempted to show you that your body is not on a one-way street in the direction of disability and death. There is a lot we can actively do to prevent this from happening prematurely. Just eat right, supplement (if you have symptoms), exercise and be active. Soon you will no longer be aware of your previously achy joints or muscles, as the pain tends to melt away when you are reconditioned.

In many previous blogs I have mentioned that bioidentical hormone replacement prolongs life. Here is a more detailed look at what such hormone replacement looks like for both women and men. Before I get into details I want to stress that I am talking about replacing what is missing and replacing only with natural hormones, not some artificial hormone derivative produced by a drug company. The reason this is immensely important is that hormone receptors in the body are distributed all over our vital organs including bones, blood vessels and the nervous system. If there is no lock and key fit (bio-identical hormone fitting the hormone receptor), there is trouble as the Women’s Health Initiative in 2002 has shown. Unfortunately they had used synthetic hormones for HRT that were not fitting the hormone receptors, and this caused many problems (heart attacks, strokes, osteoporosis, cancer).

Physiology of aging

As we age, we gradually produce fewer hormones in our hormone glands, but the various hormone glands deteriorate in their functions at different rates. Beyond the age of 30 we produce less melatonin and less growth hormone. As a result our sleep pattern may change, as melatonin is necessary for a deep sleep. The decreasing growth hormone production means that we are losing some of our muscle mass and accumulate more fat in the subcutaneous tissues. Our adrenal glands produce less DHEA at the age of 35 to 40, a hormone that is a precursor to our sex hormones in males and females. The gonads (testicles and ovaries) also produce fewer hormones, a process which already starts 5 years before menopause and about 5 years before andropause (the male menopause equivalent).

Typically a woman will get into menopause at the age of 45 to 55 at which time the periods stop and postmenopausal symptoms are interfering with her well-being. Men get into andropause (the male equivalent of menopause) at the age of 55 to 65 at which time erectile dysfunction occurs and often the individual will become the “grumpy old man”.

Other hormones such as thyroid hormones are also affected by the slow down. Hypothyroidism is common in people above the age of 50.

Bioidentical Hormone Replacement

Baseline laboratory tests

In order to know what is going on, the physician or naturopath needs to order a number of tests to assess whether there is inflammation, how your key hormone levels are; the cardiovascular system markers should also be checked, the liver enzymes and vitamin D3 level. Inflammatory markers are fasting insulin levels and C-reactive protein (CRP). Fasting cholesterol and subfractions (HDL, LDL, VDLP, small LDL) and fasting triglycerides are also measured. Thyroid hormones (T3 and T4, TSH) are measured to rule out over or under function. Typically hypothyroidism is found, which would have to be rectified by taking Armour (a mix of T3 and T4 thyroid hormones).

At this point I need to explain that long time ago the research by Dr. Lee has shown that progesterone hormone levels are notoriously unreliable when blood tests are done. All of the other sex hormones, and cortisol are also not that reliable with blood tests. For this reason the saliva hormone tests have been invented that conveniently report a panel of 5 hormones from one saliva sample: DHEAS (which is the storage form of DHEA), estradiol (the major estrogen in a woman), progesterone, testosterone and cortisol. The saliva hormone tests correlate very well with the actual tissue hormone levels. You can order the saliva tests through Dr. Lee’s website. Another longstanding lab in the US is Dr. David Zava’s lab. In Canada the Rocky Mountain Analytical Lab can process your saliva tests.

Women’s hormone replacement

Let us assume that a woman is getting postmenopausal symptoms and bioidentical hormone replacement is being discussed. The physician will want to first rule out that insulin resistance is not present by ordering a fasting insulin level. If this is normal and the other baseline tests are normal as well except for missing estrogen and progesterone, the physician will usually start to replace progesterone first using a bioidentical hormone cream to be applied once or twice per day. If estrogen levels were also low, the next step in 4 weeks or so is to add Bi-Est, a bioidentical estrogen replacement cream. After 8 weeks of hormone replacement the saliva hormone test is repeated to see whether the estrogen and progesterone levels have come up and also, whether the ratio of progesterone to estrogen is at least 200 or more. Dr. Lee has extensively researched this and found that women with a ratio of less than 200 to 1 (progesterone/estrogen ratio) were more prone to breast cancer. He also stated in this link that there are 3 basic rules with regard to bioidentical hormone replacement:

1. only replace hormones, when they were measured to be low.

2. use only bioidentical hormones (never synthetic hormones) and

3. only replace with low doses of bioidentical hormones to bring hormone levels to physiological levels (body levels that were experienced to be normal before).

Many women who are not replaced in menopause have estrogen dominance meaning that the progesterone/estrogen ratio is less than 200:1, which puts these women at risk of developing breast cancer. Women who are overweight or obese also are estrogen dominant (from estrogen produced in excess through aromatase in the fatty tissue, explained further below), which makes them more prone to breast cancer, uterine cancer and colon cancer. Without bioidentical hormone replacement inflammatory processes take place in the joints (causing arthritis), in the nervous system (causing Alzheimer’s and dementia) and in the blood vessels (causing heart attacks and strokes). Rebalancing your hormones to a youthful state by paying attention to the hormone levels and the hormone ratios mentioned will remove the inflammatory reactions and reduce the risk for cancer.

Men’s hormone replacement

Males enter andropause 10 to 15 years later than women are entering menopause. Typically testosterone production slows down leading to hair loss, erectile dysfunction, loss of muscle mass, osteoporosis and Alzheimer’s/dementia. Blood tests (bioavailable testosterone) or saliva tests are both reliable in determining a deficiency. Replacement with bioidentical hormone creams once per day is the preferred method of treatment. Overweight and obese men produce significant amounts of estrogen through an enzyme localized in fatty tissue, called aromatase.

Similar to women, where the progesterone/estrogen ratio is important, there is another ratio for men, called testosterone/estrogen ratio. This should be in the 20 to 40 range for a man to feel good and energetic. Unfortunately many men above the age of 55 have testosterone/estrogen ratios much smaller than 20. This makes them more prone to heart disease and prostate cancer (Ref.1).

However, a male also does need a small amount of estrogen and normal thyroid hormones as well as all of the other hormones for his “hormonal symphony” (mentioned in Ref. 2) to function at his best.

In the US there is a collective experience of about 25 years on thousands of patients, but there have not been any randomized studies, as Big Pharma that would have the money to finance such studies is not interested in proving that bioidentical drugs would be safer than their distorted synthetic hormone copies that will not fit the body’s hormone receptors. There are some noble exceptions as Big Pharma is producing bioidentical insulin and human growth hormone that had toxicity studies done and showed safety. In Europe bioidentical hormones have been used since the 1960’s, on a larger scale since the 1970’s. So the European experience of safety of bioidentical hormones is presently about 40 to 50 years.

The FDA is contributing to the confusion of the public as can be seen from this publication. One example where the FDA is confusing the consumer, is the progesterone product Prometrium, a bioidentical micronized progesterone capsule that can be taken by mouth. By law the manufacturer had to put a warning label on the package identical to progestin, which is the synthetic, non-bioidentical hormone having been shown to have severe side effects. As is explained in this last publication Prometrium should not have been required to have a warning label in it ; the paper explains what I have already stated above, namely that bioidentical hormones are the safest form of hormone replacement and administered in the right ratios will actually prevent cancer and prevent premature cardiovascular and joint deterioration. In other words, bioidentical hormone replacement can add many years of useful life when started early enough before permanent organ damage sets in from the aging process (which would be due to missing hormones).

Why bother about hormone replacement?

Nature has a plan of “knocking us off” to make room for the next generation. The only way that you can change nature’s plan of killing us prematurely through cardiovascular disease, arthritis, dementia and loss of your sexual life is by bioidentical hormone replacement. Of course you also need the other ingredients of known life prolongers such as healthy (preferably organic) foods, exercise and detoxification. Many women are scared to treat the hormone deficiencies that cause their menopausal symptoms because of the Women’s health Initiative results with synthetic hormones. Men who would benefit from testosterone are often anxious that they may get prostate cancer, when in reality it is the exact opposite: testosterone prevents prostate cancer (Ref.3).

Conclusion

I wrote this blog about bioidentical hormone replacement in order to clarify this often-misunderstood topic. Don’t get confused by the FDA, by highbrow medical websites (such as the likes I mentioned). Big Pharma has a powerful lobby that attempts to keep the medical profession in the belief that their products are better than those that nature has provided (I call it “defend your patent rights”). We are still in a flux state where anybody who tells the truth about hormones gets much criticism. In another few decades it will be an accepted fact and people will wonder why the Women’s Health Initiative was done without a control with bioidentical hormones. With bioidentical hormone replacement you can add about 20 years of youthful life without disabilities to the normal life expectancy. Exercise, detoxification and organic food with avoidance of wheat, starch and sugar can add another 5 to 10 years to your life. The baby boomers are lucky that they have this new tool to prolong life. I wonder whether they will put it to good use.

Recently a story went through the media regarding the findings of a research group from McMaster University, Hamilton/Ont. that described that as men were dating younger women evolution took fertility away from aging women. It sounds to me that this research, which included computer modelling was mainly driven by sociological observations. Some older males may seek out female partners that have the same age as their daughters, which seems to be considered “socially acceptable”. Contrary to that successful relationships of older females with younger partners are often met with less tolerance! It seems that medical facts like hormonal changes that are behind behaviors have not been taken into account. The following blog is meant to give you a background of hormonal changes for both sexes as we age and what can be done today to reset the clock for males and females alike to an age between 30 and 35, which creates a “level playing field”. It is a 101 on bio-identical hormone replacement.

Depleting hormones due to aging

Both men and women experience a slow decrease in hormone production beyond the age of 30, but the depletion occurs somewhat faster in women than in men. As a result women get menopause at the age of 45 to 55 (cessation of periods and postmenopausal symptoms) and men get into andropause (the male equivalent of menopause) at the age of 55 to 65. The main symptom of andropause is erectile dysfunction. These are acceptable simple physiological facts that have been known to endocrinologists since the 1950’s to 1960’s. Common sense would suggest that replacing missing hormones with bioidentical hormones should bring the body chemistry back to normal. However, this is not what conventional medicine has done. Instead, Big Pharma got wind of how powerful hormones were, and they developed hormone-like substances that could be patented and produced on a large scale. What they did not disclose initially was the fact that non-bioidentical hormones with side-chains and chlorine or fluoride atoms in the molecules would cause heart attacks, strokes and blood clots. An example of this is Premarin, an estrogen concoction that is derived from pregnant mares and Provera, a “progesterone-unlike” synthetic product, both of which were used for HRT (“hormone replacement therapy”).

Aging And Lack Of Hormones Matter, Not Evolution

Results of the Women’s Health Initiative (using synthetic hormones)

As there were conflicting reports about the benefit of hormone replacement after menopause in the medical literature, the National Institutes of Health funded a large study (the Women’s Health Initiative) to clarify what was going on with regard to side effects and effects of HRT. Unfortunately, synthetic non-bioidentical hormone products were used in these studies (Premarin and Provera) instead of bioidentical estrogen and progesterone. The results of the Women’s Health Initiative were devastating. In 2002 doctors were warned that Premarin and Provera used as HRT would cause increased heart attack rates and breasts cancer, which led to premature death. Overall the placebo group did better than the experimental group and this is why the trial was prematurely stopped. As a result of the wide publicity regarding the negative results of the Women’s Health Initiative postmenopausal women either do not see their physician for hormone replacement or are advised by conventional doctors that only small amounts of Premarin could be used for not more than 5 years for fear of causing breast cancer. Medico-legal considerations are at play and the whole issue of HRT after menopause has been politicized.

Facts about bioidentical hormone replacement therapy (BHRT)

The key with menopause or andropause is to accurately determine what the hormone levels are, which requires saliva hormone tests, not blood tests. The results are compared to what is normal for a 30 to 35 year-old person and missing hormones are replaced with bio-identical hormones as originally suggested by Dr. John Lee some time ago. Briefly, he mentioned 3 fundamental rules in bioidentical hormone replacement: first, only replace those hormones that are missing; secondly, use bioidentical hormones instead of synthetic hormones and thirdly, use the smaller doses that are enough to replace the normal hormone levels that the body had around your mid thirties, don’t over treat. He also stated that lifestyle issues like poor diets, excessive alcohol intake, stress and insulin resistance (from obesity) needed to be addressed. His recommendations are still valid today, as hormone facts have not changed.

So, the physician or naturopath needs to use common sense and replace what is missing with bio-identical hormones (not with synthetic hormone-like drugs that make the patient sick). If this is done properly, a normal sex life persists in both males and females and both age at a much slower pace without the development of heart attacks, strokes or osteoporosis. When hormones are rebalanced and a proper diet and regular exercise are also adhered to, diseases like diabetes, cancer, osteoporosis, heart attacks, strokes, arthritis or high blood pressure do not develop. In other words disabilities are prevented and you are able to enjoy an active life in vibrant health.

More info on bioidentical hormone replacement

Eventually all of us, male or female succumb to the hormone deficiencies that are associated with aging. As long as the hormones are still produced, males will have a normal sex drive, but 10 or 20 years beyond the point where their partners entered menopause erectile dysfunction will eventually set in. Just taking Viagra is no substitute for the missing testosterone and other hormones. Without paying attention to hormone restoration the biological clock is ticking and we will get the diseases mentioned above that lead to premature death. On the other hand with male hormone restoration (bioidentical testosterone) the body chemistry and physiological functions return to how they were in his 30’s. The same is true for female hormone restoration (using estriol/estradiol and progesterone).

The irony is that back in the 1960’s and 1970’s in Europe bioidentical hormone replacement was already suggested and practiced by a small number of physicians with amazing success. One of these doctors is Dr. Hertoghe, an endocrinologist in Belgium. They were able to show then that women could regain their sexual desire and their vitality with bioidentical hormone replacement (BHRT). For some reason (could it be greed?) Big Pharma and various government agencies were able to get the upper hand and suppress this knowledge all with the notion that factory produced hormones would be of a “higher quality” than bioidentical hormone creams from compounding pharmacies. Fortunately these lies have been exposed in numerous publications and the information is now more easily accessible through the use of the Internet. But Big Pharma still tries to intimidate and twist the truth! Here is a recently published prospective study over 3 years involving 300 women from Texas (Women’s Wellness Center, Tyler, Texas, USA) that showed anti-inflammatory effects and anti-anxiety effects with bioidentical hormone replacement. It also showed that no biochemical changes took place that would have caused changes in fibrinogen levels affecting clotting, inflammation to cause heart attacks or other indications to cause cancer. This confirms what Moskowitz had stated in 2006 about the safety of bioidentical hormones.

The irony is that for male hormone replacement with testosterone a lot of the hormone preparations produced by Big Pharma are actually bioidentical testosterone products. It is with women’s hormones that Big Pharma made substantial chemical modifications so that the final products did not fit the estrogen and progesterone receptors, causing heart attacks, blood clots and breast cancer.

Both women and men should get a saliva hormone panel test measuring DHEA-S (storage form of DHEA), estradiol, testosterone, progesterone and cortisol from one sample test tube when they become hormone deficient. Typically a woman should get tested first around the age of 35 to 40, a man around the age of 45 to 55. The treating physician or naturopath can then decide, whether bioidentical hormone replacement is necessary. If so, only what is missing is replaced with bioidentical hormone creams from a compounding pharmacy to the point where the hormone levels would have been around the age of 30 to 35 according to the principles by Dr. Lee. For A4M physicians this is a routine that is familiar. Your regular physician will likely feel uncomfortable, but many naturopaths will feel very comfortable doing this.

Discussion of the evolutional study of McMaster University

Although it may sound intriguing to rationalize that older men like to date and marry younger women, in my medical opinion these researchers got it wrong. As hormone weaknesses manifest themselves perhaps 10 years later in men than in women (in some men even 20 years later), older men may find themselves without a sex partner in their own age group, if women of their age do not use bioidentical hormone replacement. The McMaster team should have done their research including a control group with men and women who used bioidentical hormone replacement. They likely would have noticed that the sex drive of older women on bioidentical hormone replacement would still be the same as that of younger women in their 30’s. Also, the “aging clock” would have slowed down in these women, which in turn would probably have resulted in a different behavior pattern among the older males.

Incoming search terms:

Baldness can be embarrassing to the person who has it. Often it runs in families, as there is a genetic factor that can be passed on from mother’s and father’s side. It can even jump one generation. I have reviewed hormonal factors and the treatment with minoxidil under Ref. 1 and 2.

One particularly embarrassing form of baldness is a spotty hair loss (medically known as “alopecia areata”), which can occur spontaneously after a period of severe stress. It is due to an autoimmune phenomenon as explained here.

Recently a randomized trial was published where one half of the head was treated with either platelet rich plasma injections (PRP), corticosteroid injections or placebo injections. Each person of the 45 volunteers got three treatments in monthly intervals and they were followed for 1 year. Only the PRP treatment group had successful regrowth of hair in the bald spots. This study has caught the attention of the media. Images of vampires drinking blood were circulating in the press, but nothing could be further from the truth. Unfortunately a story like this just instills fear in the public, but does nothing to clarify what was done in this clinical trial.

Baldness Can Be Treated With Platelet Rich Plasma

Let me explain what the authors of the above baldness study actually did and why.

PRP has been shown in the past to contain various growth factors that support stem cells. So, in order to stimulate the stem cells in the baldness spots to renew hair growth blood was drawn from the same patient (there are no incompatibility issues with regard to transplant rejection). The blood sample was then placed in a centrifuge to separate the red blood cells, which go to the bottom of the test tube, from the other cells. The portion of the blood just above the red blood cells contains platelets and fibrinogen. This is called PRP or platelet rich plasma (blood without red blood cells is called plasma).

The plasma is enriched more than 4 times from the original concentration of platelets in blood. Platelets are special blood cells, which take part in the clotting process. They also contain a lot of growth factors that are all-important for the survival of the stem cells in the baldness spots. The PRP helps the dormant hair follicles in the bald spots to regrow hair. In the past PRP has been extensively researched for the treatment of musculoskeletal injuries.

With respect to treatment of baldness according to this website PRP injections alone help only in about 30% of patients to slow down hair loss and to rejuvenate hair growth. This link also contains a “before and after” picture of a PRP treated scalp. Note that this patient did not receive a hair transplant, just PRP injections. What happened here is that the PRP injections transferred platelets with growth factors from the patient’s blood. Some of the hair growth was from stimulated dormant hair follicles that were still in the patient’s scalp at the bald spot; however, other hair follicles likely developed from mesenchymal stem cells that were situated in the scalp, but activated by PRP (like grass seeds that would grow grass when put in fertile soil and watered).

Here is a YouTube video, which explains stem cell therapy for thickening of thinned hair with the use of something called Acell and PRP.

In this 2011 paper it was describes that PRP and other factors can stimulate hair growth, in some cases histology proof was even obtained showing that hair follicles had grown to a normal size following the stimulation from PRP and other factors. One important such other growth factor is the so-called Acell, which is a special application of extracellular matrix: With the help of this acellular material that functions as a matrix for hair follicles to grow the success rate of Acell and PRP injections has vastly improved. Estimates are that there are 70% to 80% success rates with this form of treatment (Acell and PRP). Here is a website where this type of treatment is also discussed.

Conclusion

In those cases of baldness where minoxidil and bioidentical testosterone replacements fail, treatment with the patient’s own PRP and augmented by the use of Acell material as a matrix can be an alternative form of treatment. Although so far only one randomized trial has shown good results, other trials from different centers will likely soon confirm this treatment modality.

Dr. Ray Schilling

Dr. Ray Schilling born in Tübingen, Germany and Graduated from Eberhard-Karls-University Medical School, Tuebingen in 1971. Once Post-doctoral cancer research position holder at the Ontario Cancer Institute in Toronto, is now a member of the American Academy of Anti-Aging Medicine (A4M). [About Dr. Ray Schilling …]